退行性颈椎脊髓病的各种手术治疗方法比较：倾向评分匹配分析
A Comparison of Various Surgical Treatments for Degenerative Cervical Myelopathy: A Propensity Score Matched Analysis.
作者信息
Lee Nathan J, Kim Jun S, Park Paul, Riew K Daniel
机构信息
Department of Orthopaedics, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA.
出版信息
Global Spine J. 2022 Jul;12(6):1109-1118. doi: 10.1177/2192568220976092. Epub 2020 Dec 30.
STUDY DESIGN
Retrospective Cohort.
OBJECTIVE
To compare the short-term outcomes for Laminoplasty, Laminectomy/fusion, and ACDF.
METHODS
We utilized a prospectively-collected, multi-center national database with a propensity score matching algorithm to compare the short-term outcomes for laminoplasty, laminectomy/fusion, and multi-level (3) ACDF (with and without corpectomy). Bivariate analyses involved both chi-square/fisher exact test and t-test/ANOVA on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes.
RESULTS
546 patients remained after propensity score matching, with 182 patients in each cohort. ACDF required the longest operative time 188 ± 79 versus laminectomy/fusion (169 ± 75, p = 0.017), and laminoplasty (167 ± 66, p = 0.004). ACDF required the shortest hospital stay (LOS ≥ 2: ACDF 56.6%, laminoplasty 89.6%, laminectomy/fusion 93.4%, p < 0.05). ACDF had lower overall complications (ACDF 3.9%, laminoplasty 7.7%, laminectomy/fusion 11.5%, p < 0.05), mortality (ACDF 0%, laminoplasty 0.55%, laminectomy/fusion 2.2%, p < 0.05), and unplanned readmissions (ACDF 4.4%, laminoplasty 4.4%, laminectomy/fusion 9.9%, p < 0.05). No significant differences were seen in the other outcomes including DVT/PT, acute renal failure, UTI, stroke, cardiac complications, or sepsis. In the multivariate analysis, laminectomy/fusion (OR 17, reference: ACDF) and laminoplasty (OR10, reference: ACDF) were strong independent risk factors for LOS ≥ 2 days. Laminectomy/fusion (OR 3.2, reference: ACDF) was an independent predictor for any adverse events 30-days after surgery.
CONCLUSIONS
Laminectomy/fusion carries the highest risk for morbidity, mortality, and unplanned readmissions in the short-term postoperative period. Laminoplasty and ACDF cases carry similar short-term complications risks. ACDF is significantly associated with the longest operative duration and shortest LOS without an increase in individual or overall complications, readmissions, or reoperations.
研究设计
回顾性队列研究。
目的
比较椎板成形术、椎板切除术/融合术和前路颈椎间盘切除融合术（ACDF）的短期疗效。
方法
我们利用一个前瞻性收集的多中心全国数据库，采用倾向评分匹配算法，比较椎板成形术、椎板切除术/融合术和多节段（3节段）ACDF（有或无椎体次全切除术）的短期疗效。对围手术期因素进行双变量分析，采用卡方检验/费舍尔精确检验和t检验/方差分析。进行多变量分析以确定短期疗效的独立危险因素。
结果
倾向评分匹配后剩余546例患者，每组182例。ACDF手术时间最长（188±79分钟），与椎板切除术/融合术（169±75分钟，p = 0.017）和椎板成形术（167±66分钟，p = 0.004）相比。ACDF住院时间最短（住院时间≥2天：ACDF为56.6%，椎板成形术为89.6%，椎板切除术/融合术为93.4%，p < 0.05）。ACDF总体并发症发生率较低（ACDF为3.9%，椎板成形术为7.7%，椎板切除术/融合术为11.5%，p < 0.05），死亡率（ACDF为0%，椎板成形术为0.55%，椎板切除术/融合术为2.2%，p < 0.05）和非计划再入院率（ACDF为4.4%，椎板成形术为4.4%，椎板切除术/融合术为9.9%，p < 0.05）。在其他结局方面，包括深静脉血栓形成/肺栓塞、急性肾衰竭、尿路感染、中风、心脏并发症或败血症，未观察到显著差异。在多变量分析中，椎板切除术/融合术（比值比17，参照：ACDF）和椎板成形术（比值比10，参照：ACDF）是住院时间≥2天的强有力独立危险因素。椎板切除术/融合术（比值比3.2，参照：ACDF）是术后30天内任何不良事件的独立预测因素。
结论
椎板切除术/融合术在术后短期内发生发病、死亡和非计划再入院的风险最高。椎板成形术和ACDF病例的短期并发症风险相似。ACDF与最长手术持续时间和最短住院时间显著相关，且个体或总体并发症、再入院或再次手术均未增加。
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